Besteht ein Zusammenhang von Alkoholkonsum und sexuellem Risikoverhalten? Eine Diskussion konzeptioneller Aspekte am Beispiel HIV-infizierter Männer mit homosexuellem Verhalten

Zusammenfassung: Besteht ein Zusammenhang zwischen Alkoholkonsum und sexuellen Risikokontakten? Führt Alkohol zu Risikokontakten? Es lassen sich zahlreiche Studien finden, die diese Frage bejaht haben. Ebenso lassen sich Studien finden, die mit modifizierten Forschungskonzepten diese Befunde nicht bestätigen konnten. Unter Verwendung von ereignisunspezifischen und situationsspezifischen Konzepten wurden diese Fragen bei einer Stichprobe von 64 HIV-infizierten Männern mit homosexuellem Verhalten untersucht. Einen signifikanten Zusammenhang von Alkoholkonsum und sexuellem Risikoverhalten konnten wir mit dem ereignisun-spezifischen Ansatz nicht feststellen. Auch Personen, die sexuelle Kontakte unter Alkoholeinfluss eingegangen waren (situationsspezifisches Konzept), gingen nicht überdurchschnittlich häufiger Risikokontakte ein. Die Personen hingegen, die unter Alkoholkonsum riskante sexuelle Praktiken eingegangen waren, erreichen sowohl hinsichtlich des Alkoholkonsums als auch des allgemein erfassten Schutz- und Risikoverhaltens lediglich Durchschnittswerte. Erst konkrete Zusatzfragen machen es möglich, sie als Personen mit Risikoverhalten zu identifizieren. Für Untersuchungen zum sexuellen Schutz- und Risikoverhalten erscheint die Kombination sich ergänzender Forschungskonzepte zweckmässi

García, Xavier (ed.) (2015). Joan Oliver-Joaquim Molas: Diàleg epistolar il·lustrat (1959-1982). Lleida: Pagès Editors, pp. 186

<p><i>Objectives</i>: Attention-deficit/hyperactivity disorder (ADHD) has been associated with spatial working memory as well as frontostriatal core deficits. However, it is still unclear how the link between these frontostriatal deficits and working memory function in ADHD differs in children and adults. This study examined spatial working memory in adults and children with ADHD, focussing on identifying regions demonstrating age-invariant or age-dependent abnormalities. <i>Methods</i>: We used functional magnetic resonance imaging to examine a group of 26 children and 35 adults to study load manipulated spatial working memory in patients and controls. <i>Results</i>: In comparison to healthy controls, patients demonstrated reduced positive parietal and frontostriatal load effects, i.e., less increase in brain activity from low to high load, despite similar task performance. In addition, younger patients showed negative load effects, i.e., a decrease in brain activity from low to high load, in medial prefrontal regions. Load effect differences between ADHD and controls that differed between age groups were found predominantly in prefrontal regions. Age-invariant load effect differences occurred predominantly in frontostriatal regions. <i>Conclusions</i>: The age-dependent deviations support the role of prefrontal maturation and compensation in ADHD, while the age-invariant alterations observed in frontostriatal regions provide further evidence that these regions reflect a core pathophysiology in ADHD.</p

Besteht ein Zusammenhang von Alkoholkonsum und sexuellem Risikoverhalten? Eine Diskussion konzeptioneller Aspekte am Beispiel HIV-infizierter Männer mit homosexuellem Verhalten

Besteht ein Zusammenhang zwischen Alkoholkonsum und sexuellen Risikokontakten? Führt Alkohol zu Risikokontakten? Es lassen sich zahlreiche Studien finden, die diese Frage bejaht haben. Ebenso lassen sich Studien finden, die mit modifizierten Forschungskonzepten diese Befunde nicht bestätigen konnten. Unter Verwendung von ereignisunspezifischen und situationsspezifischen Konzepten wurden diese Fragen bei einer Stichprobe von 64 HIV-infizierten Männern mit homosexuellem Verhalten untersucht. Einen signifikanten Zusammenhang von Alkoholkonsum und sexuellem Risikoverhalten konnten wir mit dem ereignisun-spezifischen Ansatz nicht feststellen. Auch Personen, die sexuelle Kontakte unter Alkoholeinfluss eingegangen waren (situationsspezifisches Konzept), gingen nicht überdurchschnittlich häufiger Risikokontakte ein. Die Personen hingegen, die unter Alkoholkonsum riskante sexuelle Praktiken eingegangen waren, erreichen sowohl hinsichtlich des Alkoholkonsums als auch des allgemein erfassten Schutz- und Risikoverhaltens lediglich Durchschnittswerte. Erst konkrete Zusatzfragen machen es möglich, sie als Personen mit Risikoverhalten zu identifizieren. Für Untersuchungen zum sexuellen Schutz- und Risikoverhalten erscheint die Kombination sich ergänzender Forschungskonzepte zweckmässi

Influence of the cholinergic agonist RS 86 on normal sleep: sex and age effects

In 36 healthy control subjects (21 females, 15 males; age range 18-65 years; mean age 41.8 years, SD 15.6 years), a bedtime dose of 1.5 mg RS 86, an orally acting cholinergic agonist, shortened rapid eye movement (REM) latency, increased REM sleep, and decreased slow-wave sleep. Six of the subjects (greater than 40 years old) even displayed sleep-onset REM periods after the drug. Results of the present study agree well with those of studies using other cholinomimetics (i.e., physostigmine, arecholine) and confirm the importance of the cholinergic system for REM sleep regulation. Since RS 86 mimicked some of the REM sleep abnormalities specific for patients with depressive disorders, the cholinergic system may play a role in the pathogenesis and pathophysiology of depressive diseases

Gibt es Prädiktoren für sexuelles Risikoverhalten bei HIV-Infizierten?

The influence of four coping strategies ("rumination," "search for affiliation," "threat minimization," and "search for information"), four social network dimensions ("affectively positive," "affectively negative," "accepting confidants," and "liking confidants") and sociodemographics on the sexual risk behavior of HIV-infected persons were analyzed in sexual encounters with steady and casual partners. The analysis examines bi- and multivariately the predictors for sexual risk behavior. The study population consisted of 103 asymptomatic HIV-infected persons (80 men, 23 women, mean age 34 years, range 21-69 years) who participated in our prospective study and reported their sexual contacts during the previous 6 months. In sexual encounters with steady partners, the risk of unprotected behavior increased with the frequency of sexual contact. In these encounters, coping strategies and social network had no influence on sexual risk behavior. In sexual contacts with casual partners, the number of contacts with these partners was also of importance. The coping strategy "rumination" correlates significantly with enhanced risk behavior. In sexual contacts with casual partners, there was no correlation between sexual risk behavior and the three other coping strategies or social network. In multivariate analysis, the number of sexual contacts was the only significant predictor for sexual risk behavior with steady partners as well as casual ones. As sexual activity with HIV-infected persons is not absolutely safe, further prevention campaigns have to focus more on the motivation for safe sex, its situational aspects, and partners' responsibility

Differential diagnosis, comorbidity, and treatment of attention-deficit/hyperactivity disorder in relation to bipolar disorder or borderline personality disorder in adults

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) in adults can resemble, and often co-occurs with, bipolar disorder (BD) and borderline personality disorder (BPD). This can lead to mistaken diagnoses and ineffective treatment, resulting in potentially serious adverse consequences. All three conditions can substantially impair well-being and functioning, while BD and BPD are associated with suicidality. OBJECTIVES: To update clinicians on the overlap and differences in the symptomatology of ADHD versus BD and BPD in adults; differential diagnosis of ADHD from BD and BPD in adults; and diagnosis and treatment of adults with comorbid ADHD-BD or ADHD-BPD. METHODS: We searched four databases, referred to the new Diagnostic and Statistical Manual of Mental Disorders, 5th edition, used other relevant literature, and referred to our own clinical experience. RESULTS: ADHD coexists in ∼20% of adults with BD or BPD. BD is episodic, with periods of normal mood although not necessarily function. In patients with comorbid ADHD-BD, ADHD symptoms are apparent between BD episodes. BPD and ADHD are associated with chronic trait-like symptoms and impairments. Overlapping symptoms of BPD and ADHD include impulsivity and emotional dysregulation. Symptoms of BPD but not ADHD include frantically avoiding real/imagined abandonment, suicidal behavior, self-harm, chronic feelings of emptiness, and stress-related paranoia/severe dissociation. Consensus expert opinion recommends that BD episodes should be treated first in patients with comorbid ADHD, and these patients may need treatment in stages (e.g. mood stabilizer[s], then a stimulant/atomoxetine). Data is scarce and mixed about whether stimulants or atomoxetine exacerbate mania in comorbid ADHD-BD. BPD is primarily treated with psychotherapy. Principles of dialectical behavioral treatment for BPD may successfully treat ADHD in adults, as an adjunct to medication. No fully evidence-based pharmacotherapy exists for core BPD symptoms, although some medications may be effective for individual symptom domains, e.g. impulsivity (shared by ADHD and BPD). In our experience, treatment of ADHD should be considered when treating comorbid personality disorders. CONCLUSIONS: It is important to accurately diagnose ADHD, BD, and BPD to ensure correct targeting of treatments and improvements in patient outcomes. However, there is a shortage of data about treatment of adults with ADHD and comorbid BD or BPD

Adult attention-deficit/hyperactivity disorder, risky substance use and substance use disorders: a follow-up study among young men

We investigated whether adult attention-deficit/hyperactivity disorder (ADHD) predicts risky substance use and substance use disorders (SUDs), and its impact on the course of these problematic substance use patterns. Our sample included 4975 Swiss men (mean age 20 ± 1.2 years) who participated in the baseline and 15-month follow-up assessments of the Cohort Study on Substance Use Risk Factors. We examined: (1) the contribution of ADHD, as assessed at baseline, on the risky use of alcohol, nicotine and cannabis, and their corresponding use disorders (AUD, NUD, CUD) at follow-up; and (2) the association between ADHD and the course of outcomes (i.e., absence, initiation, maturing out, persistence) over 15 months. All analyses were adjusted for socio-demographics and co-morbidity. Men with ADHD were more likely to exhibit persistent risky alcohol and nicotine use, and to mature out of risky cannabis use. ADHD at baseline was positively linked to AUD and negatively to CUD at follow-up, but not to NUD. For all SUDs, ADHD had a positive association with use persistence and maturing out. Comparing these two trajectories revealed that early age of alcohol use initiation distinguished between persistence and maturing out of AUD, while the course of NUD and CUD was related to ADHD symptoms and SUD severity at baseline. Already in their early twenties, men with ADHD are especially likely to exhibit persistent problematic substance use patterns. Substance-specific prevention strategies, particularly implemented before early adulthood, may be crucial to reducing the development and persistence of pathological patterns in such individuals

Initial REM sleep suppression by clomipramine: a prognostic tool for treatment response in patients with a major depressive disorder

sample of 82 depressed patients, that the amount of rapid eye movement (REM) sleep suppres-sion during the initial 2 nights of treatment with amitriptyline correlated positively with clinical response. Gillin et al. (1978) were able to rep-licate this finding in six depressed patients. From these results, it may be speculated that poly-somnographic measurement of REM sleep in patients during the initial nights of treatment with ~tidepressive drugs may offer the possi-bility of improving drug therapy. Whereas in clinical practice the response to antidepressive medication can only be evaluated after at least 10-14 days of medication (Woggon 1983), the predictive value of REM sleep changes may al-low us to avoid unsuccessful treatment early in the course of therapy. The above-cited studies raise the question of whether or not it is possible to establish the threshold of initial REM sleep suppression ecessary for successful drug ther-apy, thereby providing a substantial differen-tiai-therapeutic tool that could influence the choice of drug or dosage. The aim of the presen

Longitudinal Analysis of Self-Reported Symptoms, Behavioral Measures, and Event-Related Potential Components of a Cued Go/NoGo Task in Adults With Attention-Deficit/Hyperactivity Disorder and Controls

This study characterizes a large sample of adults with attention-deficit/hyperactivity disorder (ADHD) and healthy controls regarding their task performance and neurophysiology; cross-sectionally and longitudinally. Self-reported symptoms, behavioral measures, and event-related potentials from a classical cued Go/NoGo task were used to outline the symptom burden, executive function deficits and neurophysiological features, and the associations between these domains. The study participants (N = 210 ADHD, N = 158 controls, age: 18-62 years) were assessed five (ADHD) or three (controls) times over two years. We describe cross-sectional and longitudinal group differences, and associations between symptom burden, and behavioral and event-related potential (ERP) components variables by latent growth curve models, including random slopes and intercepts. The ADHD group showed increased reaction time variability, increased commission and omission errors, and attenuated cueP3, CNV, N2d, and P3d amplitudes. We observed a decrease in self-reported symptoms in the ADHD group over the two years. The behavioral measures (reaction time variability, number of omission, and commission errors) did not change over time, whereas the cueP3, P3d, and N2d amplitude attenuated in both groups. There was no evidence for a robust association between symptom burden and behavioral or ERP measures. The changes in the ERP components with stable task performance, potentially indicate more efficient neuronal processing over the two years. Whether the lack of association between symptom burden and behavioral or ERP measures might be due to the low reliability of the ADHD assessment criteria, or the inappropriateness of the objective measures cannot be inferred

Description of the study sample and correlates of adult ADHD; logistic regression analyses with ADHD as the outcome variable.

†<p>p<.10,</p><p>*p<.05,</p><p>**p<.001;</p>a<p>adjusted for all variables;</p>b<p>age range: 17–28;</p>c<p>no logistic regression analyses were performed due to the small number of participants in one of the variable’s categories;</p>d<p>before 18 years of age.</p